Healthcare Provider Details

I. General information

NPI: 1861121345
Provider Name (Legal Business Name): MUTIYA AYOKA OLATOKUNBO OLORUNFEMI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BENMORE DR STE 200
WINTER PARK FL
32792-4111
US

IV. Provider business mailing address

14700 E OLD US HIGHWAY 12
CHELSEA MI
48118-1185
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-7070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME173853
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: